https://journals.lww.com/jcrjournal/pages/currenttoc.aspx
en-usMon, 19 Mar 2018 09:07:08 -0500Wolters Kluwer Health RSS Generatorhttps://images.journals.lww.com/jcrjournal/XLargeThumb.01273116-201803000-00000.CV.jpeghttps://journals.lww.com/jcrjournal/pages/currenttoc.aspx
https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Exercise_Rehabilitation_for_Peripheral_Artery.1.aspx
Purpose:
To summarize evidence regarding exercise therapy for people with lower extremity peripheral artery disease (PAD).
Methods:
Literature was reviewed regarding optimal strategies for delivering exercise interventions for people with PAD. Randomized trial evidence and recent studies were emphasized.
Results:
Randomized clinical trial evidence consistently demonstrates that supervised treadmill exercise improves treadmill walking performance in people with PAD. A meta-analysis of 25 randomized trials (1054 participants) concluded that supervised treadmill exercise was associated with 180 m of improvement in maximal treadmill walking distance and 128 m of improvement in pain-free walking distance compared with a control group. Three randomized trials of 493 patients with PAD demonstrated that home-based walking exercise interventions that incorporate behavioral change techniques improve walking ability in patients with PAD. Furthermore, evidence suggests that home-based walking exercise improves the 6-min walk more than supervised treadmill exercise. Upper and lower extremity ergometry also significantly improved walking endurance in PAD. The Centers for Medicare & Medicaid Services recently determined that Medicare would cover 12 wk (36 sessions) of supervised treadmill exercise for patients with PAD.
Conclusions:
Supervised treadmill exercise and home-based walking exercise each improve walking ability in patients with PAD. The availability of insurance coverage for supervised treadmill exercise for patients with PAD will make supervised treadmill exercise more widely available and accessible. Home-based exercise that incorporates behavioral change technique is an effective alternative for patients unwilling or unable to attend 3 supervised exercise sessions per week.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00001https://journals.lww.com/jcrjournal/Fulltext/2018/03000/A_Systematic_Review_of_Exercise_Training_in.2.aspx
Purpose:
This systematic review identified exercise-based intervention studies in patients with cardiac implantable devices (CIDs): implantable cardioverter defibrillator (ICD), cardiac resynchronization pacemaker or defibrillator (cardiac resynchronization therapy [CRT]), or ventricular assist device (VAD) and assessed evidence for the safety and efficacy of exercise-based interventions alone or in combination with psychoeducational components.
Methods:
PubMed, EMBASE, CINAHL Plus, Web of Science, Cochrane, and PEDro databases were searched from database inception to September 2016. Data were extracted and validity was assessed by 2 reviewers. Study quality was evaluated using the JADAD scale for randomized controlled trials. A total of 3991 articles for all CIDs (ICD: 1015; pacemaker: 1630; and VAD: 1346) were screened for relevance. Subsequently, 24 full-text articles (ICD: 14; CRT: 4; and VAD: 6) were deemed eligible for this review.
Results:
Studies of aerobic exercise training demonstrated an average increase in peak oxygen uptake of 2.61 mL/kg/min, (ICD = 2.43, VAD = 2.2, and CRT = 3.2 mL/kg/min). These incremental increases were statistically significant when compared with the usual care or other comparison groups. Adverse event rates were very low at 1.1% to 2.2% for all CIDs.
Conclusion:
Exercise interventions tested to date in the CID population (ICD, CRT, and VAD) indicate that exercise training at moderate to high intensity is safe and effective in improving cardiopulmonary outcomes without adverse events. Future investigations should include a more diverse sample of participants, designs that include translation of exercise to routine practice, the destination therapy VAD population, and measurement of costs and patient-centered outcomes.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00002https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Short__and_Longer_Term_Association_Between_Body.3.aspx
Purpose:
The association between body mass index (BMI) and subjective health status before and after cardiac rehabilitation (CR) and 1 year later was compared in patients undergoing primary percutaneous coronary intervention (pPCI) who did (CR group) and did not receive CR (no-CR group). The aim was to investigate the association between BMI and subjective health status based on the Short Form-12 questionnaire.
Methods:
Between 2009 and 2011, 242 patients with pPCI with an acute myocardial infarction completed a CR program and were compared with 115 patients in the no-CR group. All patients completed the Short Form-12 questionnaire at baseline, at 12 weeks, and at 1-year followup. The CR program consisted of a 2 sessions per week for 1.5 hours each for 12 weeks. Patients were categorized into 3 groups based on BMI: normal weight, overweight, and obese.
Results:
Compared with patients in the no-CR group, CR group patients in the overweight group significantly improved their subjective health status after CR and these improvements were sustained at 1-year followup. CR patients in the normal weight and obese groups did not significantly improve subjective health status. The overweight patients had the highest improvement in subjective health status (OR = 3.4 post-CR and 5.1 at 1 year of followup).
Conclusions:
After CR, overweight patients showed the best improvement in subjective health status. CR did not significantly improve subjective health status in normal-weight and obese patients.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00003https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Validation_of_the_English_Version_of_the_HeartQoL.4.aspx
Purpose:
The aim of this study was to validate the English version of the HeartQoL health-related quality of life questionnaire for use in patients with angina or myocardial infarction.
Methods:
Patients living in the United States and referred, either for percutaneous coronary intervention or to cardiac rehabilitation, completed the HeartQoL, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale at baseline and 3-months later. The data were analyzed for validity, reliability, and responsiveness.
Results:
Patients (n = 313 with angina and n = 97 with myocardial infarction) who were referred either for percutaneous coronary intervention (n = 164) or to cardiac rehabilitation (n = 246) completed baseline questionnaires. Patients with angina had significantly lower HeartQoL scores (poorer health-related quality of life) compared with patients with myocardial infarction. Exploratory factor analysis largely supported the 2-factor structure of the HeartQoL in both diagnoses, but further investigation is warranted. Internal consistency reliability was adequate, convergent validity correlations were significant, and discriminative validity was fully confirmed in patients with angina and largely confirmed in patients with myocardial infarction. Responsiveness was largely confirmed in patients who underwent percutaneous coronary intervention (n = 67) and those referred to cardiac rehabilitation (n = 167) with conventional statistical tests and clinically with the effect size, a standardized measure of change.
Conclusions:
The English HeartQoL health-related quality of life questionnaire is valid, reliable, and responsive in patients with angina and myocardial infarction allowing (1) assessment of baseline, (2) between-diagnosis comparisons, and (3) evaluation of change over time.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00004https://journals.lww.com/jcrjournal/Fulltext/2018/03000/The_Community_Balance_and_Mobility_Scale__A_VALID.5.aspx
Purpose:
Many patients participating in cardiac rehabilitation (CR) programs have decreased balance. This is a concern, as it may affect their ability to optimally perform physical exercise in CR and thus decrease CR efficacy. Despite this concern, balance is typically not assessed as part of CR intake. This may be attributable to the fact that a suitable balance assessment tool has not been identified for higher-functioning CR patients. A potential solution to this issue is using the Community Balance and Mobility Scale (CBMS), which has been used to assess balance in higher-functioning clinical populations; however, its use in a CR population has never been investigated. Therefore, the purpose of this study was to determine the reliability and validity of the CBMS for assessing balance in CR patients.
Methods:
Fifty-three participants were recruited from local CR programs to perform the CBMS. Dynamic posturography was also measured in a subset of participants (n = 31) using the Limits of Stability (LOS) test.
Results:
Analysis of CBMS scores revealed that the mean CBMS score was 61.9 ± 16.2 (out of 96) and that no floor or ceiling effects were observed for any participants. CBMS scores were significantly correlated with the LOS results (0.41-0.53). Interrater reliability between novice and expert testers was strong (r = 0.95), with all differences falling within the 95% limits of agreement.
Conclusion:
Overall, these results suggest that the CBMS is a valid tool to measure balance in CR patients and can be reliably administered by health care professionals with minimal training.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00005https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Psychosocial_Determinants_of_Weight_Loss_Among.6.aspx
Purpose:
The ardent wish to lose weight, drive for thinness (DT), might be 1 psychosocial contributor to weight loss (WL) in adults with overweight and obesity. In examining DT as a predictor of WL, it is important to determine whether its predictive value is equal in males and females and whether it exerts its effects primarily through changes in diet or physical activity (PA).
Methods:
Two-hundred three men and women with overweight and obesity (body mass index >25 kg/m2; aged 21-35 years; 47% female) participated in this 12-month observational study. DT score and demographic information were collected at baseline. Participants were measured at quarterly intervals for objectively measured PA, energy intake, and anthropometrics. Linear mixed regression analyses determined whether DT predicted WL over time and whether these effects were moderated by sex. Followup mediation analyses determined whether the effects of DT on WL could be explained by either changes in diet or PA.
Results:
Females reported higher DT as compared with males at baseline (P < .001). We observed a significant sex × time × DT interaction on WL (P < .04), such that higher DT predicted WL in males (P < .04), but not in females (P = .54). This effect of DT on WL in overweight and obese males was mediated by changes in PA (indirect effect, −0.43; 95% CI, −1.52 to −0.05), but not changes in energy intake.
Conclusions:
Among young adults with overweight and obesity who have higher DT, PA appears to be more important to WL than caloric restriction, particularly in males.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00006https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Effects_of___Blockers_on_Maximal_Heart_Rate.7.aspx
Purpose:
To derive specific maximal heart rate (HRmax) prediction equations for a coronary artery disease (CAD) population based upon status of β-blocker (BB) therapy and to compare these to prior HRmax equations (Fox and Brawner-specific for CAD).
Methods:
We retrospectively reviewed stress echocardiogram treadmill tests in patients with CAD, dividing subjects into 3 groups based upon BB use on test day: not prescribed BB therapy (no BB group; n = 110); held for 12 to 24 hr prior (held BB group; n = 155); and continued taking (took BB group; n = 72).
Results:
Derived HRmax equations for our CAD population were no BB = 200 − 0.79 × age; held BB = 193 − 0.71 × age; and took BB = 168 − 0.51 × age. Achieved HRmax mean was not significantly different between held BB and no BB groups; however, HRmax in the took BB group was significantly lower. Fox and Brawner (no BB)-HRmax equations significantly overestimated (+6 and +9 mean bias) and underestimated (−8 and −6 mean bias) achieved HRmax in no BB and held BB groups, respectively. The Brawner (no BB) equation intercept and slope were not significantly different from our CAD-held BB and no BB equations. The Brawner (on BB) equation intercept and slope were similar to our took BB equation, but greatly underestimated achieved HRmax (−17 mean bias).
Conclusion:
For patients holding BB therapy on test day, a similar CAD HRmax estimation equation to those patients never on BB can be used, comparable to the Brawner (no BB) equation. Further research is needed to determine when patients should take their BB therapy in conjunction with exercise testing.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00007https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Variability_in_Quality_of_Life_Outcomes_Following.8.aspx
Purpose:
Pulmonary rehabilitation (PR) improves exercise tolerance in patients with chronic obstructive pulmonary disease. However, it is unclear why some patients do not improve quality of life during a training program. Our objective was to evaluate the differences between patients with chronic obstructive pulmonary disease who improve and those who do not improve quality of life during a pulmonary rehabilitation program.
Methods:
Seventy-three patients underwent a PR program. All patients trained at 80% (legs) and 50% (arms) of their maximum load. Incremental and endurance tests, 6-min walk test, and health-related quality of life with the St George Respiratory Questionnaire (SGRQ) were measured. We subdivided the groups based on a decrease ≥4 points in the pre- and post-PR SGRQ total score (G1); <4-point change in the SGRQ total score (G2); and an increase in scores ≥4 points (G3).
Results:
Exacerbation frequency (P = .004) and SGRQ total scores (P < .001) were lower in G1 and G2 than in G3. G1 (P = .0007) and G2 (P = .0005) significantly improved 6-min walk test distance. Before PR, G1 and G2 walked greater distances than G3 (P = .003); however, the difference was no longer significant after PR (P = .34). A significant load increase was seen after PR for the 3 groups (P < .05). We found a significant correlation between the SGRQ and the Charlson index (r = 0.78, P < .0001), exacerbation frequency (r = 0.72, P < .0001), and basal dyspnea index (r = −0.48, P < .0001).
Conclusion:
Patients whose quality of life did not improve after comprehensive PR presented a higher number of disease-related exacerbations with comorbidities.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00008https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Efficacy_of_a_Structured_Exercise_Program_for.9.aspx
Purpose:
This study investigated the effects of an exercise program on functional capacity and quality of life in patients with stage 3 and stage 4 sarcoidosis.
Methods:
Eighteen patients with stage 3 and 4 sarcoidosis were recruited; 9 received 12 wk of supervised exercise training and 9 received usual care. Patients underwent the following evaluations at baseline and follow-up: 6-min walk test, maximal inspiratory and expiratory pressure tests, back and leg dynamometer test, modified Medical Research Council Dyspnea Scale, Fatigue Severity Scale, St George Respiratory Questionnaire, Short Form-36 Quality of Life Questionnaire, Hospital Anxiety and Depression Questionnaire, body plethysmography, carbon monoxide diffusing capacity test, and blood gas analysis.
Results:
The median (interquartile range) increase in 6-min walk distance in the intervention group was 40 (31-62) m. Improvement in functional capacity; perception of dyspnea; fatigue; anxiety; peripheral and inspiratory muscle strength; partial arterial oxygen pressure; arterial oxygen saturation; and the symptom, activity, and total scores of the St George Respiratory Questionnaire were significantly greater in the intervention group than in the usual care group at follow-up (P < .05).
Conclusions:
Exercise training improves functional capacity, muscle strength, dyspnea, quality of life, anxiety, fatigue, and oxygenation in patients with stage 3 and stage 4 sarcoidosis. Standard treatment of patients with late-stage sarcoidosis should integrate exercise training and pulmonary rehabilitation.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00009https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Pulmonary_Rehabilitation_in_Patients_With_Advanced.10.aspx
Purpose:
Currently, pulmonary rehabilitation (PR) has a weak recommendation for idiopathic pulmonary fibrosis (IPF) and is often recommended for mild to moderate disease. We aimed to investigate the completion rate of PR in patients with advanced IPF, to analyze whether the severity of disease influences PR response and whether there is any difference between subjects who are able or not able to successfully complete the program.
Methods:
Patients with IPF referred to lung transplantation (n = 48) were enrolled in an outpatient PR program including 3 times/wk supervised exercise training during 12 wk. A short-form 36-item health-related quality-of-life (HRQL) questionnaire and 6-min walk test distance (6MWD) were evaluated before and after PR.
Results:
We found that 64.5% of patients successfully completed PR (31/48). Baseline forced vital capacity (FVC) and lung diffusion capacity for carbon monoxide (DLCO) were 49% ± 13% and 46% ± 17% of predicted, respectively. There was no difference comparing those who did and did not complete PR. In the former group, 6MWD (58 ± 63 m) and several domains of the HRQL questionnaire improved significantly. No significant association was found between markers of disease severity (FVC, DLCO, and dyspnea) and improvement in clinical outcomes.
Conclusions:
Two-thirds of our sample with advanced IPF referred to lung transplant successfully attended PR and improved exercise capacity and HRQL, without association with markers of disease severity. No difference was found at baseline compared with subjects who were not able to complete the program.]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00010https://journals.lww.com/jcrjournal/Fulltext/2018/03000/Selected_Abstracts_From_Recent_Publications_in.11.aspx
No abstract available]]>Thu, 01 Mar 2018 00:00:00 GMT-06:0001273116-201803000-00011